| NPI | 1093069106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 62014) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN 9580) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: AZ 9430) | |
| Enumeration Date | 2012-10-29 |
| Last Update Date | 2016-05-02 |